Article Text

  1. M Koelch1,
  2. A Gradert1,
  3. P L Plener1,
  4. H Cario2,
  5. N C Schmidt2
  1. 1Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
  2. 2Department of Paediatrics, University Hospital of Ulm, Ulm, Germany


Objective Clinicians have to be aware of psychological causes in cases of somatic complaints. Individualized treatment regimen and interdisciplinary treatment can optimize outcome.

Method A six-year-old girl was presented to a paediatric ward with extremely low BMI (11.15 Kg/m2, <3 perc.), weight loss, severe exsiccosis, bradycardia and central hypothyroidism. The girl complained about abdominal pain and pain on swallowing. After three weeks of intensive diagnostic work up without finding any somatic cause, the girl was seen in liaison by a child psychiatrist and moved to child psychiatric inpatient unit. During the stay at the paediatric ward parenteral nutrition was necessary and rooming in was provided for the parents.

Results The patient presented with depressed state, loss of affect modulation and age inappropriate behaviour. Psychopathology and IQ (79) were assessed and the diagnosis of an atypical eating disorder (DSM-IV 307.50, ICD-10 F50.8) with concomitant depression and anxiety was verified. A CBT therapy program was established (token-system, cognitive modulation of triggers for anxiety). Rooming in was abandoned due to an inadequate (overprotecting) child–parent relationship. No substitution of nutrition was provided under strict control of vital signs and labs. Within a short period the girl starts drinking and eating. Two weeks later symptoms had disappeared and mood was normalized, and the central hypothyroidism which had normalized under parenteral nutrition didn’t reappear.

Discussion Interdisciplinary treatment in cases of children with both somatic complaints and psychopathological symptoms is important and may shorten inpatient treatment. In this case it led to the final treatment success.

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